COVID-19 and Palliative Care Services: Comparative Patterns of Inpatient, Outpatient, and Consultation Services in a Tertiary Care Center in Riyadh

The Logistics of Medication and Patient Flow in Video-Based Virtual Clinics During a Sudden COVID-19 Outbreak in Taiwan: Observational Study

Background

The COVID-19 pandemic was well controlled in Taiwan until an outbreak in May 2021. Telemedicine was rapidly implemented to avoid further patient exposure and to unload the already burdened medical system.

Objective

To understand the effect of COVID-19 on the implementation of video-based virtual clinic visits during this outbreak, we analyzed the logistics of prescribing medications and patient flow for such virtual visits at a tertiary medical center.

Methods

We retrospectively collected information on video-based virtual clinic visits and face-to-face outpatient visits from May 1 to August 31, 2021, from the administrative database at National Taiwan University Hospital. The number of daily new confirmed COVID-19 cases in Taiwan was obtained from an open resource.

Results

There were 782 virtual clinic visits during these 3 months, mostly for the departments of internal medicine, neurology, and surgery. The 3 most common categories of medications prescribed were cardiovascular, diabetic, and gastrointestinal, of which cardiovascular medications comprised around one-third of all medications prescribed during virtual clinic visits. The number of virtual clinic visits was significantly correlated with the number of daily new confirmed COVID-19 cases, with approximately a 20-day delay (correlation coefficient 0.735; P<.001). The patient waiting time for video-based virtual clinic visits was significantly shorter compared with face-to-face clinic visits during the same period (median 3, IQR 2-6 min vs median 20, IQR 9-42 min; rank sum P<.001). Although the time saved was appreciated by the patients, online payment with direct delivery of medications without the need to visit a hospital was still their major concern.

Conclusions

Our data showed that video-based virtual clinics can be implemented rapidly after a COVID-19 outbreak. The virtual clinics were efficient, as demonstrated by the significantly reduced waiting time. However, there are still some barriers to the large-scale implementation of video-based virtual clinics. Better preparation is required to improve performance in possible future large outbreaks.

Tele-clinics in palliative care during the COVID-19 outbreak: Tertiary care cancer center experience

OBJECTIVES

To investigate the effect of tele-clinics on palliative care patients during the COVID-19 pandemic.

METHODS

This is a retrospective cross-sectional study (chart review) carried out from March 17, 2020, to September 16, 2020, included all patients who were booked into the palliative care clinic. Patients were assessed by the palliative nurse specialist for COVID-19 symptoms using the acute respiratory illness screening form and Edmonton Symptoms Assessment System, also identifies the needs of the patient. Data were analyzed to investigate the effect of tele-clinics on the patients regarding ER visits and admission.

RESULTS

A total of 167 individuals were analyzed and the results showed that 234 of 447 visits were virtual, supporting the increasing value of telemedicine. The number of virtual patients' visits dropped slightly at the beginning of the pandemic (46.4% in March to 39.8% in July). Subsequently, it increased steadily to 72.2% in September. The choice of virtual/non-virtual visits for individuals with cancer diagnosis significantly depends on other factors. Code status, palliative patients or follow-up service, and the frequency of oncology center visits, admissions, or ER visits were crucial in explaining the means of receiving treatment.

CONCLUSION

Virtual visits in palliative care are efficient means of decreasing the threat of COVID-19 contagion. It is recommended to increase the palliative care patients' awareness of tele-clinics and their positive outcomes, particularly during the pandemic.

Home-Based Palliative Care and Home Health Care in Saudi Arabia: An Integrative Literature Review

Aging populations and a rising disease burden have increased the need for palliative care (PC). Despite the growing demand for PC, only 14% of patients worldwide receive this service. Home-based PC is necessary because many people prefer to receive care and die at home. Nurses are well equipped to address diverse health care needs in the community and are critical to successful delivery of home-based PC. The purpose of this review is to synthesize and analyze literature relevant to home-based PC in Saudi Arabia with an emphasis on nursing. This purpose required us to examine literature in two areas: PC and home health care (HHC). We identified studies through database searches. We found 24 studies published between 2005 and 2021 that met quality and inclusion criteria. Although PC and HHC are associated with positive outcomes, lack of nurses’ knowledge and awareness of PC and the underdevelopment of HHC in Saudi Arabia have contributed to underuse of these services. Nurses are vital to the functioning of interdisciplinary teams and effective interfacing with patients, caregivers, and families. Education and training of nurses in Saudi Arabia is essential to promoting access to PC and HHC and the development of home-based PC in the kingdom.

Impact of the COVID-19 Pandemic on Palliative Care in Cancer Patients in Spain

Background: The COVID-19 pandemic outbreak has severely affected healthcare organizations worldwide, and the provision of palliative care (PC) to cancer patients has been no exception. The aim of this paper was to analyse the levels of health care provided by the Clinical Management Unit for PC in Córdoba (Spain) for cancer patients. Method: a retrospective cohort study was conducted. It analyzed the PC internal management database including all cancer patients treated in the period of 2018–2021. Results: 1967 cases were studied. There was a drop in cancer cases (p = 0.008), deaths at the PC hospital (p < 0.001), and referrals from primary care (p < 0.001). However, there was a rise in highly complex clinical situations (p = 0.020) and in ECOG performance status scores of 3–4 (p < 0.001). The pandemic was not shown to be a risk factor for survival in the PC program (0.99 [0.82–1.20]; p = 0.931). However, being female (p = 0.005), being older and having a high Karnofsky Performance Status (KPS) score (p < 0.001) could be indicators of a longer stay. Conclusion: The COVID-19 pandemic has presented a challenge in the management of patients requiring PC and has highlighted the urgent needs of the healthcare system if it is to continue providing a level of care which meets the needs of patients and their families.